Arthroscopically Assisted Treatment of Volar Rim Fractures

Abstract

Background Arthroscopically-assisted reduction and internal fixation (AARIF) for distal radius fractures (DRF) has been extensively described. Little information is available about AARIF in AO “B3” and “C” DRF with displaced lunate facet volar rim fragment (VRF) and volar carpal subluxation. However, lunate volar rim fragment (LVRF) may be very difficult to reduce and fix under arthroscopic control using the flexor carpi radialis (FCR) or FCR extended approaches while traction is applied. Purposes The aims were to describe our surgical technique of AARIF of partial or complete DRF with VRF and provide information about how often this technique may be necessary, based on a large DRF database. Methods The dual-window volar approach for complete articular AO C DRF with volar medial fragment was described in 2012 for performing open reduction internal fixation (ORIF). Since 2015, we have used the dual-window approach for AARIF of “B3” or “C” DRF with volar carpal subluxation. We analyzed our PAF database, searching for patients treated with AARIF in “B3” and “C” fractures. Results The dual-window volar approach is very useful when using AARIF for AO “B3” and “C” DRF with displaced VRF and volar carpal subluxation. The anteromedial part of the exposure allows a direct access to reduction and fixation of the LVRF under traction and arthroscopic control. Overall, 1% of all articular DRF in this series showed a displaced LVRF amenable to the dual-window volar approach. Conclusion It is almost impossible to access and properly fix a VRF using traction and arthroscopic control through the FCR or FCR extended FCR approach because of the stretched flexor tendon mass. The use of the dual-window approach during AARIF of AO “B3” or “C” DRF has not previously been reported. Displaced VRF are rare whether they were part of “B3” or “C” fractures. If AARIF is chosen, we strongly recommend the use of the dual-window volar approach for AO “B3” and “C” fractures with VRF. A single anteromedial approach can also be used for isolated “B3” anteromedial DRF.

Anatomical and Clinical Concepts in Distal Radius Volar Ulnar Corner fractures

“…It is a combination of the modified Henry approach and an anteromedial approach between the flexor mass/median nerve and the ulnar pedicle. 23 The incision is extended in a distal and ulnar direction, which allows the flexor tendon mass to be retracted radially, to enable visualization of the volar ulnar corner through the more ulnar sided window. An advantage of this approach is that while the wrist is in traction and the flexor mass is taught, the exposure is not compromised and visualization of the volar ulnar side is achievable through the ulnar-sided window.…”

“…Arthroscopic-assisted reduction and internal fixation is a recognized technique, which has been recently revised to ensure adequate access to the ulnar column of the distal radius. 23 This can all be done while the wrist is in the traction tower that may aid with reduction. With the addition of more distal plating options, intra-articular screw penetration is a risk.…”

Volar Rim Fractures of the Distal Radius: Can We Reduce the Complications and Need for Revision Surgery?

“…1). [1][2][3][4][5][6][7][8] Clarnette et al provided a paper on the mapping of the volar rim fractures and how they relate to the osteoligamentous units (►Fig. 2).…”

“…6 Herzberg et al reviewed the role of wrist arthroscopy in defining the associated ligament injuries, and how to stabilize the fractures. 7 He described how the dual-window approach can be used to expose the distal radius while using traction for wrist arthroscopy (►Fig. 7).…”